Changes in dietary fiber intake among Japanese in the 20th century: a relationship to the prevalence of diverticular disease

Abstract

In view of the fact that Japanese dietary patterns have been undergoing rapid "Westernization," in part characterized by decrease in fiber, we assessed dietary and crude fiber content in the Japanese diet using food consumption tables for the period from 1911 to 1980, and studied the trend in the reported prevalence of diverticular disease of the colon. Fiber content declined in diphasic pattern: the first decline, which probably had started in the late 19th century, progressed until the Second World War. Although records during the war period were unavailable, the high fiber content of the Japanese diet in the period immediately after the war reflects the tendency to supplement rice with more fiber-rich cereals, and to increase the amount of rice through reduced polishing during the war time. The second decline in fiber content in the Japanese diet, which started in the 1950s and progressed throughout the period of "high economic growth," was mainly due to the decrease in cereal consumption. The changes in crude fiber content in the Japanese diet after the Second World War resemble the pattern of rapid decline noted in the United States during the 1930s to the 1950s. The prevalence of diverticular disease in both countries also shows sudden steep upward turns during the period between 1930 and 1950 in the United States and the late 1970s in Japan, suggesting the presence of threshold level(s) of fiber intake for the effective prevention of diverticular disease. The prevalence of diverticular disease is still relatively low in Japan. However, if the current dietary trend continues, it may rise to a level currently found in the "Western" countries in the coming few decades.

Endoscopic band ligation for colonic diverticular hemorrhage

“…8 Although many reports of endoscopic treatment for colonic diverticular hemorrhage are in patients from Western countries in whom diverticula arise mainly in the left side of the colon, diverticula are more common in the right side of the colon in Asian populations. [9][10][11][12][13] Right-sided diverticulosis has been shown to be associated with more massive hemorrhage 13,14 and can be considered easier to observe in the right side of the colon, especially ascending colon (straight shape) than in the left side of the colon, especially sigmoid colon (curved shape) on colonoscopy. These characteristics might have an influence on the higher rate of identification of the diverticula with stigmata on colonoscopy in our study.…”

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

“…Colonic diverticulosis is an acquired disease caused by an increased intestinal pressure due to the decreased intake of dietary fiber and mu-causes complications such as diverticulitis or bleeding. Diverticular bleeding has been reported to be the most common cause of lower gastrointestinal bleeding (4,5) and accounts for >40% of lower gastrointestinal bleeding (5). Colonic diverticular bleeding typically has a mild course and stops spontaneously without therapeutic intervention in approximately 70% to 80% of cases (5)(6)(7)(8).…”

Enodoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage

“…Colonic diverticulosis has been increasing in Japan because of increasing low-fiber diets. Concomitantly, the incidence of diverticular hemorrhage is increasing due to regular use of antiplatelet agents and nonsteroidal antiinflammatory drugs (NSAIDs) [4,5]. Diverticular hemorrhage has a less severe course than upper gastrointestinal bleeding and stops spontaneously in 70-80% of cases [1,6].…”